Index
A
Accountability, 19, 21, 155-156, 163, 168
SCHIP, 2, 14, 18, 42, 105, 118, 168
technical aspects, 22, 163-168
see also Performance measures
Acute illness, 5, 22, 47, 55, 72, 120, 121-122, 124-126, 137
see also Emergency care;
Injuries
Administrative barriers, 20, 54, 56, 113
Children's Medical Security Plan, 113
information technology and, 133
Medicaid, 87-88, 103, 113, 115, 150
special needs children, 127
vouchers, 150
Adults, 1
coverage trends, 22, 24-29, 151
disabled, defined, 131
needs, vs children, 19, 136, 151, 164
SCHIP, 70
state programs, subsidy structure, 111, 121
subsidies, 151
Supplemental Security Income, 130
uninsured, 4, 24, 26, 27, 68, 70
see also Employer-based insurance;
Parents
AFDC, see Aid to Families with Dependent Children
African Americans
access to care, 41, 49, 51, 53, 54
insurance coverage, 3, 27, 32-33
Age factors
access to health care, 44
employer-based insurance, 27, 30-31
insurance coverage status, 21, 27, 30-31
Medicaid eligibility, 5, 83-84, 114
poverty thresholds, 38
see also Adults
Agency for Health Care Policy and Research, 17, 52, 157-158, 163
Aid to Families with Dependent Children, 12, 88, 96, 97
see also TANF
AIDS, see Human immunodeficiency virus
Alcohol and drug abuse, see Substance abuse
Ambulatory care,
see Emergency care;
Outpatient care;
Primary care
Ambulatory Care Access Project, 47
American Academy of Pediatrics, 17, 55, 60
American Indians, see Native Americans
Arizona, 79
Asians/Pacific Islanders, 27, 32-33, 34, 53-54
Assessment, see Accountability;
Evaluation
Asthma, 3, 5, 46, 48, 53, 115, 117, 124, 125, 166
Attitudes
welfare recipients, embarrassment, 87-88, 104, 113
see also Health beliefs
Auditory disabilities, see Hearing impairments
B
Balanced Budget Act of 1997, 38, 68, 72, 85, 98-99, 128, 167
see also SCHIP
Behavioral disorders, 60, 98, 124, 128
Benchmark coverage, 61, 137, 140
Black persons, see African Americans
Block grants, 2, 4, 14, 69, 75, 79, 124, 125, 127, 128-129
Blue Cross/Blue Shield, 103, 115, 116, 126, 137
Bureau of Primary Health Care Programs, 69
Buy-in, Medicaid, 98
See also Cost sharing;
Sliding scale
C
Caring Programs, 25, 55, 103, 106, 107, 109, 116
Case management, 5, 60, 61, 72, 89, 91, 120, 125, 126, 129, 131, 132, 165
see also Coordination of care
Catastrophic health insurance, 84, 108, 146, 148, 150
CHAMPUS, 25
Charity, see Safety net providers
Child care (day care), 7, 20, 21, 129, 131
Child Health Plus, 106, 109, 111, 114
Children's Health Trust Fund, 2, 14
Children's hospitals, 1, 14, 67, 72, 75, 77, 131, 134
Children's Medical Security Plan, 110, 112-113
Chronic conditions, 5, 19, 22, 25, 55, 92, 108, 117, 120, 123-127, 131, 167
see also Special needs children;
specific conditions
Cigarette tax, see Tobacco tax
Civilian Health and Medical Program of the Uniformed Services, see CHAMPUS
Clinical assessments, 58, 75, 84, 92, 93, 133
Community health centers, 1, 124, 128, 136
AFDC population, 12
immunization, 12
private insurers and, 73
safety net providers, 67, 70, 72, 73
Computer-based approaches, see Information technology
Consumer protection, 21, 42, 99, 110, 155
see also Information infrastructure;
Public education
Continuity of care, 50, 55, 162
Coordination of care, 7, 20, 58, 60, 61, 96, 117, 118, 121, 125, 127, 129, 131, 132, 134, 137
see also Case management
Copayments, 19, 51, 52, 103, 108, 110, 112, 113, 114, 129, 145
Cost and cost-benefit factors, 6, 18, 57, 120, 161
copayments, 19, 51, 52, 103, 108, 110, 112, 113, 114, 129, 145
federal preemption of state insurance laws, 147, 148
information technology, 133
inpatient care, 75
out-of-pocket expenses, 3, 6, 38, 52, 56, 105
preventive services (well care), 57, 120
severe/chronic medical conditions, 5
special needs children, 127-128, 129, 132, 136
state-sponsored programs, 109, 112, 114, 115, 147-148
tax credits, 153
tax subsidies, 16
treatment delays, 3, 23, 25, 38, 44, 56
uncompensated care, 68, 70, 71, 79, 114
Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89
uninsured persons, costs to, 146
see also Accountability
Cost sharing, 5, 19, 34, 41, 42, 51, 52, 88, 99, 110, 113, 144, 145-146, 150
Counseling, 58, 59, 60, 78, 121, 124, 167
Crowd-out, see Substitution of coverage
Cultural factors, access to care, 52, 53, 54, 129
safety net providers, 68
see also Health beliefs
Culturally sensitive services, 3, 7, 54, 56
Current Population Survey, 2, 17, 25, 156, 157
D
Data collection and dissemination, see Current Population Survey;
Evaluation;
Information infrastructure
Deductibles, 19, 52, 127, 129, 145, 146, 148-152 (passim)
Delaware, 111
Demographic factors
educational attainment of parents, 34-37
federal data collection, 157-160;
see also Current Population Survey
see also Age factors;
Families and households;
Gender factors;
Racial/ethnic
factors;
Socioeconomic status;
specific racial/ethnic groups
Dental health and services, 3, 44, 50, 90, 91, 108, 123, 156, 161, 166
Developmental disabilities, 124, 125, 134, 166
Diabetes mellitus, 5, 46, 120, 125, 167
Digestive system diseases, 122
Digital Equipment Corporation, 162, 164-165
Disabled persons
definitions, legal, 125, 128, 130, 131
developmental disabilities, 124, 125
private programs, 117
rehabilitative care, 55
SCHIP, Medicaid eligibility, 13
Supplemental Security Income, 128, 130
state benefits, 108
utilization rates, 21
see also Special needs children
Diseases and disorders
acute illness, 5, 22, 47, 55, 72, 120, 121-122, 124-126, 137
cost factors, general, 57
injuries, 3, 5, 19, 46, 55, 92, 120, 122, 125, 158, 166
see also Chronic conditions;
Disabled persons;
Special needs children;
specific diseases, organs, and body systems
Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89
Doctors, see Family physicians;
Pediatric specialists;
Physicians
Drug-Free Schools and Communities Act, 79
Drugs, see Prescription medication;
Substance abuse
E
Ear infections, 3, 5, 46, 56, 120, 161
Early and Periodic Screening,
Diagnosis, and Treatment Program, see EPSDT
Economic factors
employer-based insurance, development of, 143-145
see also Cost and cost-benefit factors;
Funding;
Market-based approaches;
Poverty;
Socioeconomic status
Eczema, 5
Education, see Developmental disabilities;
Health education;
Public education;
School-based clinics and insurance
Educational attainment of parents, 34, 37
Eligibility, 4-5, 6, 12, 13, 14, 20, 83-86
Federal Poverty Level, employer-based insurance, eligibility, 34
family size, thresholds by, 38
Medicaid eligibility, 34, 81, 84, 85, 113
private insurers, eligibility, 116, 117
SCHIP eligibility, 13, 105, 106
state cost-sharing requirements, 42
state program eligibility, other, 110-114 (passim)
HMOs, 165
Medicaid, 4-5, 12-14, 42, 80, 83-88, 90, 96-98, 99, 103, 104, 113, 127
income thresholds, 5, 6, 13, 27, 79, 96, 150
welfare and, 4-5, 12, 88, 89, 96-99
private programs, 116
SCHIP, 5, 6, 13, 20, 42, 88, 99, 105, 106, 118, 168
special needs/disabled children, 127-128, 131
state-sponsored programs, 5, 7, 86, 88, 103, 104-108, 110, 112-115 (passim), 168
Supplemental Security Income, 130, 131
tax credits, 153
see also Outreach
Emergency care, 3, 51, 55, 68, 77, 112, 115, 117, 123, 159, 165
Emotional disturbances, see Special needs children
Employer-based insurance, 2-3, 11, 18, 23, 34, 143-146, 158
employees, cost shifts to, 11
federally mandated, 148-149, 151
injuries, 46
parents, employed, with uninsured children, 23, 34, 35, 149
small employers, 34, 108, 110, 145(n.11), 148, 149
socioeconomic status and, 23, 34, 35, 149
state-sponsored programs, 38, 40, 105, 148-149, 158, 161
statistical trends, 24, 25-34, 41, 44, 46
substitution of coverage, 27, 41-42, 105
tax policy, 144, 145, 146, 151, 153(n.32)
vouchers and, 150
Employment status
parents, 23, 34-37, 105, 116, 143, 149
self-employed persons, 110, 145, 146, 149(n.23), 151-152
Encounter data, 21, 90, 94, 128, 156
Enrollment, 7, 20, 34, 42, 118
employer-based coverage, 21, 25, 27, 143
HEDIS data, 161
Medicaid, 3, 4-5, 13, 22, 25, 41, 50, 72, 79, 83-84, 87-88, 90, 93 , 94, 95, 98, 99, 128
private plans, 116, 117, 144-145
managed care, commercial, 21, 54, 72, 89, 93, 94, 99
racial factors, 41
SCHIP, 5, 6, 13, 21, 43, 79, 88, 168
state-sponsored programs, general, 5, 20, 42, 43, 72, 86-87, 104, 105, 110-115 (passim)
Supplemental Security Income, 131
see also Outreach
EPSDT, 50, 77, 81, 83, 84, 92-94, 127, 155-156
clinical assessments, 58, 75, 84, 92, 93, 133
EPSDT, 156
managed care, 133
performance measures, 155, 156, 162-168
federal efforts, 157-160, 163, 167-168
Medicaid, 94
private sector, 163-166
special needs children, 127, 128
state programs, other, 112, 118, 167-168
special needs children, programs, 21, 127, 128
see also Accountability;
Information infrastructure
Evidence-based approach, 2, 14, 16, 18, 167, 168
F
Families and households, 34, 35-38, 52, 53, 136
emotionally disturbed children, 125
employer-based coverage, 18, 149, 151
single-parent families, 34-37, 152
see also Parents
Family physicians, 121, 131, 164
Family planning, 58, 60, 61, 90, 91, 160
Federal government
data sources, 2, 17, 156, 157-169
Current Population Survey, 2, 17, 25, 156, 157
employer-based coverage, mandated, 148-149, 151
Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89
community health care centers, 70
local services, 68
matching funds, 12, 13, 68, 84, 90, 103
school-based centers, 79
special needs children, 127, 128
see also Block grants
performance measures, 157-160, 163, 167-168
preemption of state insurance laws, 147-148
public health departments, 76
safety net providers, 68, 70, 74
state cooperation with, general, 14, 147-148, 167
tax policy, 1, 14, 22, 108, 116, 144, 145, 146, 149(n.32), 150-154
vouchers, 2, 14, 22, 149-150, 153
see also Legislation;
Medicaid;
Medicare;
SCHIP;
specific agencies
Federal Poverty Level (FPL)
employer-based insurance, eligibility, 34
family size, thresholds by, 38
Medicaid eligibility, 34, 81, 84, 85, 113
private insurers, eligibility, 116-117
SCHIP eligibility, 13, 105, 106
state cost-sharing requirements, 42
state program eligibility, other, 110, 114 (passim)
Food aid, see Nutrition
Foundation for Accountability, 162, 166
Funding
community health centers, 70, 72, 73-74
community health care centers, 70
local services, 68
matching funds, 12, 13, 68, 84, 90, 103
school-based centers, 79
special needs children, 127, 128
mental health services, 124
public health departments, 78
safety net providers, 68-70, 72, 73, 74, 79-80
school-based health centers, 79
state programs, 2, 13, 79-80, 85, 108, 110, 112, 113, 114
copayments, 103, 108, 110, 112, 113, 114
premiums, 104, 108, 110, 112, 113, 114, 116
Supplemental Nutrition Program for Women, Infants, and Children, 69, 78, 129
see also Balanced Budget Act of 1997;
Block grants;
Personal Responsibility and Work Opportunity Reconciliation Act of 1996
The Future of Public Health,75
G
Gender factors
emergency room visits, 51
single-parent families, 35, 36, 37
Georgia, 115
Government role, see Federal government;
Local government;
State government
H
Health beliefs
Hispanics, 53
parental, 25
Southeast Asians, 54
Health Care Financing Administration, 25, 94, 155, 157
Health education, 20, 21, 58, 61, 93, 115, 117, 121, 129, 133, 134 , 162, 165
counseling, 58, 59, 60, 78, 121, 167
Health insurance, general, 1-2, 13-14, 16, 17, 136-137
access to care and, 46-51
African Americans, 3, 27, 32-33
Asians/Pacific Islanders, 27, 32-33, 34
catastrophic, 84, 108, 146, 148, 150
copayments, 19, 51, 52, 103, 108, 110, 112, 113, 114, 129, 145
deductibles, 19, 52, 127, 129, 145, 146, 148-152 (passim)
information infrastructure, 20-21, 22, 25-27, 155-163
market-based approaches, 143-154
risk adjustment, 123, 136, 145
risk pools, 110
standards, benefits, 3, 5, 58, 60, 91, 92, 99, 133, 148-150
benchmark coverage, 61, 137, 140
Healthy People 2000,166-167
HMOs, 162-165
see also Eligibility;
Employer-based insurance;
Enrollment;
Medicaid;
Medicare;
Premiums;
Private health insurance;
SCHIP;
Tax policy;
Uninsured adults;
Uninsured children
Health Insurance Portability and Accountability Act of 1996, 133
Health maintenance organizations, 133, 136, 137
Digital Equipment Corporation, 162, 164-165
Health Partner, 127
Health plan Employer Data Information System, see HEDIS
Health Resources and Services Administration, see Maternal and Child Health Care Services Block Grant
Health Security Act, 148
Health services, availability and access, 1, 2, 3, 11, 13-14, 16, 17, 23, 25, 44-61, 120-139
African Americans, 41, 49, 51, 53, 54
age factors, 44
continuity of care, 50, 55, 162
cultural factors, 52, 53-54, 129
culturally sensitive services, 3, 7, 54, 56
safety net providers, 68
equipment, 5, 58, 60, 61, 120, 128, 129, 130, 131, 132, 136
financial barriers, 44-52;
see also Employment status;
Poverty;
Socioeconomic status
framework for, 45
managed care, 54-55, 79, 133, 136
nonfinancial barriers, 7, 20, 45, 53, 129-132, 136
child care (day care), 7, 20, 21, 129, 131
embarrassment, 87-88, 104, 113
transportation, 5, 7, 20, 21, 53, 67, 129, 132, 136
see also Administrative barriers
outpatient care, 3, 47, 53, 56, 58, 75, 77, 90, 112, 114, 116, 159
poverty and, general, 34, 47, 48, 52, 53, 56, 67, 83, 123, 133, 136, 166
primary care, 1, 5, 14, 34, 47, 118, 121, 124, 125, 132, 164, 165, 167
see also Coordination of care;
Safety net providers;
Uninsured adults;
Uninsured children;
specific providers and services
Health Services for Children With Special Needs, 127
Health status, general, 5-6, 120-139
adults vs children, 19, 136, 151, 164
parental, 53
poverty and, 47
risk pools, 110
see also Diseases and disorders;
Special needs children;
specificdiseases, organs, and body systems
Healthy Kids, 106, 109, 110, 112
Healthy People 2000,78, 123, 128, 162, 166-167
Hearing impairments, 3, 56, 93, 112, 125
Heart disease, 5, 90, 119, 124, 125, 126
Hispanics
health beliefs, 53
HIV, see Human immunodeficiency virus
HMOs, see Health maintenance organizations
Home health care, 67, 75, 90, 115, 158
Hospitals and hospitalization, 1, 46-48, 116, 159
asthmatics, 53
children's hospitals, 1, 14, 67, 72, 75-77, 131, 134
developmentally disabled children, 125
length of stay, 77
poor persons, 47, 53, 61, 68, 70, 77, 89
rehabilitation, 58, 60, 72, 75, 76
safety net services, 68, 72, 75, 76
Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89
state programs, 108, 112, 113, 114, 115, 116
see also Emergency care
Human immunodeficiency virus, 5, 115, 120, 128-129
I
Immunization, 3, 5, 12, 47, 49, 55, 59, 69, 78, 93, 112, 115, 120, 125, 133, 136, 137, 161, 165, 167
public health departments, 12, 133, 136
Income, see Poverty;
Socioeconomic status
Indemnity insurance, 1, 54, 126
Indians (American), see Native Americans
Infectious and parasitic diseases, 3, 48, 49, 121, 122, 167
see also Immunization;
specific diseases
Information infrastructure, 20-21, 22, 155-163, 165
coverage estimates, 25-27
federal data sources, 2, 17, 156, 157, 169
Current Population Survey, 2, 17, 25, 156, 157
standards for data, 10, 133, 156-161
study at hand, 17
see Current Population Survey;
Health education
Information technology, 20, 133, 134, 135, 161, 165, 168
federal vs private software, 156
Internet, 156
proprietary information, 156
Injuries, 3, 5, 19, 46, 55, 92, 120, 122, 125, 158, 166
Internal Revenue Service, 144, 150, 151, 152
Internet, 133, 134-135, 156, 165
J
Joint Commission on Accreditation of Health care Organizations, 161-162, 166
K
Kaiser Permanente, 116-117
L
Balanced Budget Act of 1997, 12, 38, 68, 72, 85, 98-99, 128, 167;
see also SCHIP
Drug-Free Schools and Communities Act, 79
Health Insurance Portability and Accountability Act of 1996, 133
Health Security Act, 148
history of Medicaid legislation, 84, 85
Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991, 85
Medicare Catastrophic Coverage Act of 1988, 84
Omnibus Budget Reconciliation Acts, 84, 85, 155-156
Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 12, 85, 96, 125, 131
preemption of state insurance laws, federal, 147-148
Public Health Service Act, 70, 128
safety net providers, 68
Social Security Act of 1965, 13, 69, 75, 84;
see also listings under ''Social Security Act of 1965"
Tax Payer Relief Act of 1997, 151
Length of stay, 77
Local factors
special needs children, 127, 136
state programs responsive to, 104
racial/ethnic factors, 34
see also Community health centers
Local government
community health centers, funding, 70, 72
public health departments, 77, 78
special needs children, 127
Low-income persons, see Poverty
M
Maine, 103
access issues, 54-55, 79, 133, 136
AFDC population, 12
encounter data, 90, 94, 128, 156
enrollment, commercial providers, 21, 54, 72, 89, 93, 94, 99
HMOs, 133, 136, 137, 162, 164-165
Medicaid, 4, 11, 12-13, 68, 72, 83, 89, 94-96, 98-99, 128, 137
primary care, 126, 131, 136, 164
public health departments, 78-79
state programs, 5, 102-104, 107, 112, 113, 115, 133, 136
Market-based approaches, 4, 11, 12, 72, 79, 89, 94, 104, 114, 143-154
see also Tax policy
Maryland, 79
Massachusetts, 79, 103, 105, 106, 109, 110, 111, 112-113, 137
Maternal and Child Health Care Services Block Grant (Title V, SSA) , 4, 69, 75, 79, 127, 128, 129
MCOs, see Managed care
Medica, 117
Medicaid (Title XIX, SSA), 2-5, 6, 21, 23, 27, 28, 34, 36, 81-99, 116, 136-137
administrative barriers, 87-88, 103, 113, 115, 150
buy-in, 98
community health centers, 70, 72, 73
coverage estimates, 24-33, 36, 81, 83
disabled persons, 13, 82, 84, 98, 99
EPSDT, 77, 78, 81, 83, 84, 92-94
eligibility, 4-5, 12-14, 42, 80, 83-88, 90, 96-98, 99, 103, 104, 113, 127
income thresholds, 5, 6, 13, 27, 79, 96, 150
welfare and, 4-5, 12, 88, 89, 96-99
employer-based insurance vs, 27, 41, 149
enrollment, 3, 4-5, 13, 22, 25, 41, 50, 72, 79, 83-84, 87-88, 90, 93, 94, 95, 98, 99, 128
evaluation, 21
injuries, 46
litigation by beneficiaries, 168
managed care, 4, 11, 12-13, 68, 72, 83, 89, 94-96, 98-99, 128, 137
public health departments, 78
race/ethnicity, 27-28, 32-34, 41
safety net providers, 4, 12-13, 67, 68, 69, 70, 72, 73, 77, 78, 79
SCHIP and, 2, 5, 6, 12, 13, 20, 42, 61, 83, 102, 107, 137
school-based health centers, 79
special needs children, 127-128, 136
state programs, 2, 3, 11, 83, 85, 86, 90, 93, 96, 98-99, 102-104, 107, 112, 113, 115, 137
substitution of coverage, 27, 41-42, 105-108
welfare delinking, 4-5, 12, 89, 96-98
see also Disproportionate Share Hospital payments;
Medicaid;
Medicare
Medicaid Data System, 157
Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991, 85
Medi-Cal, 116-117
Medical equipment, 5, 58, 60, 61, 120, 128, 129, 130, 131, 132, 136
Medical Expenditure Panel Survey, 157
Medical home, see Usual source of care
Medical Savings Accounts, 2, 14
Medicare
community health centers, 70, 73
statistical trends, 24, 25, 26
Medicare Catastrophic Coverage Act of 1988, 84
Mental health and illness, 123, 124, 125, 127, 131, 137, 166
behavioral disorders, 60, 98, 124, 128
school-based care, 79
substance abuse, 115, 123, 124-125, 127, 166
Mercy Health Plan, 117
Michigan, 79, 103, 106, 109, 117
Military health care, 24, 25, 26
Minnesota, 103, 106, 109, 110, 111
Minority groups, see Racial/ethnic factors;
specific groups
Missouri, 116
N
National Ambulatory Medical Care Survey, 157
National Association of Children's Hospitals and Related Institutions , 75, 77
National Cancer Institute, 126
National Center for Health Statistics, 44
National Committee for Quality Assurance, 161, 166
National Employer Health Insurance Survey, 159
National Forum on the Future of Children and Families, 58
National Health and Nutrition Examination Survey, 158
National Health Interview Survey, 158
National Health Provider Inventory, 158
National Home and Hospice Care Survey, 158
National Hospital Ambulatory Medical Care Survey, 159
National Hospital Discharge Survey, 159
National Immunization Survey, 159
National Institute of Mental Health, 124
National Medical Expenditure Survey, 34, 46, 146
National Nursing Home Survey, 159
National Survey of Ambulatory Surgery, 159
National Survey of Family Growth, 160
National Vital Statistics System, 160
Native Americans, 27
Neural system disorders, 5, 120, 125, 134-135
New Jersey, 103, 105, 109, 111
New York State, 79, 103, 106, 109, 111
North Carolina, 106, 109, 115, 116
Nurses and nursing services, 58, 60, 61, 75, 79, 90, 91, 115, 123, 127, 131, 132
Nutrition, 69, 78, 121, 125, 135, 158, 166
O
OmniCare Health Plan, 117
Oregon, 111
Organ transplants, 112
Outcome measures, see Performance measures
Out-of-pocket expenses, 3, 6, 38, 52, 56, 105, 113
special needs children, 127, 129, 132, 136
see also Copayments;
Deductibles;
Premiums
Outpatient care, 3, 47, 53, 56, 58, 75, 77, 90, 112, 114, 116, 159
see also Emergency care
Outreach, 7, 20, 34, 53, 88, 104, 110, 116
see also Public education
P
Pacific Business Group on Health, 162
Pacific Islanders, see Asians/Pacific Islanders
educational attainment, 34-37, 52
employment status, 23, 34-37, 105, 116, 143, 149
single-parent families, 34-37, 152
skills training, 121
special needs children, 121, 126, 127
tax policy, 151
Patient education, see Health education
Pediatric specialists, 5, 14, 54, 55, 58, 74, 75, 76, 90, 96, 99, 112, 118, 120, 121, 123, 124, 126, 131-136 (passim), 164
American Academy of Pediatrics, 17, 55, 60
Pennsylvania, 79, 103, 106, 109, 111, 116
Performance measures, 155, 156, 162, 168
federal efforts, 157-160, 163, 167, 168
Medicaid, 94
private sector, 163-166
special needs children, 127, 128
state programs, other, 112, 118, 167-168
see also Accountability
Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 12, 85, 96, 125, 131
Pharyngitis, 46
access to, 3, 46, 50, 52, 53, 54, 61
chronic conditions, treatment, 5
minority physicians, 53
see also Pediatric specialists
Political factors, 2, 14, 99, 147-148
Poverty
access to care, 34, 47, 48, 52, 53, 56, 67, 83, 123, 133, 136, 166
community health centers, 72
disabled children, 127
employer-based insurance and, 11, 35
Federal Poverty Level
employer-based insurance, eligibility, 34
family size, thresholds by, 38
Medicaid eligibility, 34, 81, 84, 85, 113
private insurers, eligibility, 116, 117
SCHIP eligibility, 13, 105, 106
state cost-sharing requirements, 42
state program eligibility, other, 110-114 (passim)
hospitalization, 47, 53, 61, 68, 70, 77, 89
nonfinancial barriers to access, 45, 53
preventive care, 3, 47, 133, 136
providers serving poor persons, 3
Federal Poverty Level and, 13, 105, 106
special needs children, 127, 130
state programs, general, 5, 20, 99, 103-115 (passim)
subsidies, 4, 79, 103, 104, 150, 153
substitution of coverage, 41-42, 106
uninsured persons, 2, 7, 13, 37, 47, 70, 83, 89-90
see also Safety net providers;
Welfare
private insurers, 117
state-level actions, 104, 108, 110, 112, 113, 114, 116
Prescription medication, 44, 112, 117, 195
Preventive care (well care), 5, 19, 47, 53, 55, 57-59, 120, 121, 128, 133, 161
counseling, 58, 59, 60, 78, 121, 124, 167
dental, 50
EPSDT, 77, 78, 81, 83, 84, 92-94
family planning, 58, 60, 61, 90, 91, 160
federal role, 148
Healthy People 2000,78, 123, 128, 162, 166-167
poor persons, general, 3, 47, 133, 136
private insurers, 115, 116, 164, 165
state programs, 104, 113, 114, 137
utilization rates, 21
see also Immunization
Preventive Health Block Grant, 79
access/use, 1, 5, 14, 34, 47, 118, 121, 124, 125, 132, 164, 165, 167
HEDIS, 161
managed care, 126, 131, 136, 164
private insurers, 116, 117, 164, 165
safety net providers, 4, 67, 68, 70, 79
state programs, 112-115 (passim)
Private health insurance, 2, 4, 5, 6, 18, 21-22, 24, 26, 115-118, 137, 144-145
Blue Cross/Blue Shield, 103, 115, 116, 126, 137
community health centers, 73
managed care, commercial, 21, 54, 72, 89, 93, 94, 99
Kaiser Permanente, 116-117
Medicaid, reimbursement vs, 4, 11
need-based approach, 19-20
performance measures, 163-166
preventive care, 115, 116, 164, 165
primary care, 116, 117, 164, 165
regional coverage patterns, 38, 40
special needs children, 126-127
state-level actions, 2, 5, 6, 38, 40, 102, 103-104, 115-117
substitution of coverage, 107
see also Employer-based insurance;
Health maintenance organizations;
Self-pay insurance
Public assistance, see Medicare;
Welfare
Public education, 88, 98, 116, 118, 127
see also Outreach
Public health departments
safety net providers, 67, 68, 75, 77, 79
special needs children, 55
Public health mission, 75, 104
Public Health Service Act, 70, 128
Public insurance
international comparisons, 23
see also Medicaid;
Medicare
R
Racial/ethnic factors, 21, 156
access to care, 44, 47, 49, 51, 52, 53-54, 129
coverage/utilization rates, 21, 27, 32-34
emergency room visits, 51
enrollment, 41
Regional factors
special needs children, costs, 127
specialty centers, 75
Rehabilitation services, 58, 60, 72, 75, 76, 112
Reimbursement rates for providers, 4, 5, 34, 70, 72, 89, 156
Research methodology data collection, 156
evidenced-based approach, 2, 14, 16, 18, 167, 168
funding streams, 25
report at hand, 1-2, 13-14, 16, 17
substitution of coverage, 27, 42
see also Evaluation
Respiratory diseases, 5, 48, 120, 121, 122, 124, 125
asthma, 3, 5, 46, 48, 53, 115, 117, 124, 125, 166
Risk adjustment, 123, 136, 145
Risk pools, 110
S
Safety net providers, 4, 12, 67-80
community health centers, 67, 70, 72, 73
cultural factors, 68
defined, 67-68
Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89
federal role, general, 68, 70, 74
funding, 68-70, 72, 73-74, 79-80
hospitalization, 68, 72, 75, 76
Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89
institutional vs individual approach, 18
Medicaid, 4, 12-13, 67, 68, 69, 70, 72, 73, 77, 78, 79
medium-income persons, provisions for, 42, 108, 112, 132
primary care, 4, 67, 68, 70, 79
public health departments, 67, 68, 75, 77-79
school-based programs, 67, 77, 78, 79
state-based programs, 68, 70, 72, 77, 78, 79
transportation, 67
welfare-Medicaid delinking, impact on, 12, 89, 96
see also specific providers
SCHIP (Title XXI, SSA), 2, 5, 6, 12, 13, 14, 18, 40, 61, 99, 102, 107, 110, 112, 118, 137, 168
accountability, 2, 14, 18, 42, 105, 118, 168
adults, 70
disabled persons, 13
eligibility, 5, 6, 13, 20, 42, 88, 99, 105, 106, 118, 168
enrollment, 5, 6, 13, 21, 43, 79, 88, 168
funding, 13, 42, 79-80, 85, 108
managed care and, 99
Medicaid and, 2, 5, 6, 12, 13, 20, 42, 61, 83, 102, 107, 137
outreach, 88
federal poverty level and, 13, 105, 106
performance measures, 6, 18, 21
safety net providers, 6, 70, 79-80
substitution of coverage, 27, 41-42, 105-108
School-based clinics and insurance
safety net providers, 67, 77, 78, 79
special needs children, 5-6, 136
School Lunch Program, 112
Self-employed persons, 110, 145, 146, 149(n.23), 151-152
Self-pay insurance, 145(n.11), 151
state incentives, 110
see also Vouchers
Sickle cell disease, 5, 120, 125
Single-parent families, 34-37, 152
Sliding scale, 70, 103, 110, 112-113
Small employers, 34, 108, 110, 145(n.11)(n.11), 148, 149
Social Security Act of 1965
Title V, see Maternal and Child Health Care Services Block Grant
Title XVI, see Supplemental Security Income Program
Title XIX, see Medicaid
Title XXI, see SCHIP
Socioeconomic status, 23, 34-37
medium-income persons, provisions for, 42, 108, 112, 132
state coverage, 42, 105-107, 110, 113, 114
see also Current Population Survey;
Poverty
Southeast Asians, 53-54
Specialists and special care centers, 21, 55, 72, 75, 91, 112, 125, 126, 131, 133
see also Pediatric specialists;
Rehabilitation services
Special needs children, 5-6, 19, 55, 58, 59, 75, 98, 120-121, 124-132
administrative barriers to access, 127
cost factors, 127-128, 129, 132, 136
out-of-pocket expenses, 127, 129, 132, 136
evaluation of services, 21, 127, 128
local factors, 127
managed care, 54-55
private insurers, 126-127
public coverage, 127-129
school-based programs, 5-6, 136
state-level factors, 127-128
state programs, 127, 133, 136, 137
transportation, 5, 129, 132, 136
treatment delays, 25
see also Chronic conditions;
Disabled persons;
specific conditions
Standards
data collection, 10, 133, 156-161
health care benefits, 3, 5, 58, 60, 91, 92, 99, 133, 148-150
benchmark coverage, 61, 137, 140
Healthy People 2000, 166-167
HMOs, 162-165
preventive services, 3, 58, 148
state reimbursement rates, 72
see also Eligibility
State Children's Health Insurance Program, see SCHIP
State government, 5, 21-22, 102-115, 118, 137, 162
age factors, coverage, 106, 114
community health centers, 70, 72
cost factors, 109, 112, 114, 115, 147-148
disabled persons, 108
eligibility, insurance, 5, 7, 86, 88, 103, 104-108, 110, 112-115 (passim), 168
employer-based insurance, 38, 40, 105, 148-149, 158, 161
enrollment, insurance, 5, 20, 42, 43, 72, 86-87, 104, 105, 110-115 (passim)
federal cooperation with, general, 14, 147-149, 167
Federal Poverty Level
state cost-sharing requirements, 42
state program eligibility, other, 110-114 (passim)
federal preemption of state insurance laws, 147-148
funding, 2, 13, 79-80, 85, 108, 110, 112, 113, 114
copayments, 103, 108, 110, 112, 113, 114
premiums, 104, 108, 110, 112, 113, 114, 116
hospitalization, 108, 112, 113, 114, 115, 116
managed care plans, 5, 102-104, 107, 112, 113, 115, 133, 136
Medicaid, 2, 3, 11, 83, 85, 86, 90, 93, 96, 98-99, 102-104, 107, 112, 113, 115, 137
medium-income persons, provisions for, 42, 108, 112, 132
mental health services, 108, 112, 137
multiple programs, eligibility differences, 20
performance measures, 112, 118, 167-168
poor persons, general, 5, 20, 99, 103-115 (passim)
premiums, 104, 108, 110, 112, 113, 114, 116
preventive care, 104, 113, 114, 137
primary care, 112-115 (passim)
private insurers, use of, 2, 5, 6, 38, 40, 102, 103-104, 115-117
public health departments, 77, 78
safety net providers, 68, 70, 72, 77, 78, 79
school-based health centers, 79, 112
scope of benefits, 108, 109, 112-115
self-pay insurance, 110
socioeconomic status and, 42, 105, 107, 110, 113, 114
special needs children, 127, 133, 136, 137
subsidies, 5, 42, 99, 101-115 (passim), 118, 121, 148
see also SCHIP
State-level factors, 102-115
employer-based insurance, 38, 40, 105, 148-149, 158, 161
private insurers, 2, 5, 6, 38, 40, 102, 103-104, 115-117
racial/ethnic factors, 34
school-based care, 79
special needs children, 127-128
uninsured persons, 3, 38, 40, 113, 115, 116, 117
see also specific states
Statistical programs and activities, see Information infrastructure
Subsidies, 11
employer-provided insurance, federal subsidies, 149
Medicaid, 99, 102-104, 107, 112, 113, 118
nonmedical, adjunct services, 21
poor persons, 4, 79, 103, 104, 150, 153
private insurers, 116, 117, 148
safety net providers, 4, 68, 70, 79
state programs, 5, 42, 99, 101-115 (passim), 118, 148
tax policy and, 16, 144, 145, 146, 149-153
see also Vouchers
Substance abuse, 115, 123, 124-125, 127, 166
Substance Abuse and Mental Health Services Administration, 124
Substitution of coverage, 27, 41-42, 105-108
Supplemental Nutrition Program for Women, Infants, and Children funding , 69, 78, 129
Supplemental Security Income Program (Title XVI, SSA), 84, 98, 128 , 130-131
Survey of Income and Program Participation, 34, 160
Systems of Accountability: Implementing Children's Health Insurance
T
Tax Payer Relief Act of 1997, 151
credits, 152-154
for self-insured individuals, 110
for small employers, 110
deductions, 151-152
employer-provided insurance, 144, 145, 146, 151, 153(n.32)
self-employed persons, 145, 146, 149(n.23), 151-152
health service providers, 114
Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991, 85
parents, 151
refundable family credits, 2, 14
social security tax, 108
subsidies, general, 16, 144, 145, 146, 149-153
uninsured, impact on, 150
Temporal factors
caregivers' time costs, 132
data collection, 156
HMO appointments, 164
hospitals, length of stay, 77
private insurance, 137
treatment delays, 3, 23, 25, 38, 44, 54, 56
uninsured status,
waiting periods, 114
Temporary Assistance to Needy Families (TANF), 96, 97
Tennessee, 106, 109, 110-112, 115
Texas, 79
Title V (Social Security Act), see Maternal and Child Health Care
Services Block Grant
Title XVI (Social Security Act), see Supplemental Security Income
Program
Title XIX (Social Security Act), see Medicaid
Title XXI (Social Security Act), see SCHIP
Tobacco tax, 104, 108, 113, 116
safety net providers, 67
special needs children, 5, 129, 132, 136
U
Uncompensated care, 68, 70, 71, 79, 114
Disproportionate Share Hospital payments, 4, 38, 68, 69, 70, 82, 85, 89
UniHealth, 117
Uninsured adults, 4, 24, 26, 27, 68, 70
see also Safety net providers;
SCHIP
Uninsured children, 2, 7, 13, 16, 23, 24, 34, 42, 83, 89-90
access to care, 44, 46-52, 56, 146
community health centers, 73
employed parents with, 23, 34, 149
extent of, 3, 11, 23-33, 41, 70
school-based health centers, 79
state/regional patterns, 3, 38, 40, 113, 115, 116, 117
study methodology, 1
temporal factors,
waiting periods, 114
see also Safety net providers;
SCHIP
United Health Care of Ohio, 117
U.S. Preventive Services Task Force, 59
Usual source of care, 47, 50, 52, 121
V
Vaccination, see Immunization
Visual impairments, 59, 61, 84, 93, 112, 117, 125, 130, 133, 137
Vouchers, 2, 14, 22, 149-150, 153
W
Washington, 103, 106, 109, 110, 111, 128
Welfare
IRS, involvement in, 150-151
legislative reforms, 96-99
Medicaid, delinking, 4-5, 12, 89, 96-98
tax policy and, 146
see also Aid to Families with Dependent Children;
Medicaid;
Personal Responsibility and Work Opportunity Reconciliation Act of 1996;
Safety net providers;
Supplemental Nutrition Program for Women, Infants, and Children;
Supplemental Security Income Program;
Temporary Assistanceto Needy Families
Well care, see Preventive care
emergency care, 51
immunization, 49
Women, Infants, and Children Program, see Supplemental Nutrition Program for Women, Infants, and Children
Wyoming, 103
Z
ZAP Asthma, 127